Only 8 Minutes Per Patient...

This recent piece in the New York Times, "For New Doctors, 8 Minutes Per Patient," discussed in detail one of the most pressing concerns and strains facing healthcare providers today.  The highlight quote of the article for us at Physicians Angels is as follows:

"The dramatic decrease in time spent with patients compared with previous generations appears to be linked to new constraints young doctors now face, most notably duty hour limits and electronic medical record-keeping. The study found, for example, that interns now spend almost half their days in front of a computer screen, more than they do with patients, since most documentation must be done electronically."

The article goes on to highlight studies showing lower patient satisfaction and outcomes suffering as a result of doctors having less time to interact with patients. While this New York Times piece highlights not only the challenges providers face with EMR data entry -- but with the broader, potential negative consequences of less time and increased distractions during patient care -- we feel it makes our argument for us about using medical scribes.

Medical scribes will reduce significantly the amount of time you spend staring at a computer screen, and allow you to focus on the patient during the exam room encounter.  For reasons pointed in the above cited articles, having a scribe to manage your EMR data in real-time helps not only with patient volume, but with patient satisfaction, error reduction, and "staying sharp" as a highly-trained and expert diagnostician and patient care provider.

Scribe in Clinical Practice - Additional Research Supporting the Benefits of Medical Scribes in Clinics

Researchers at The Vancouver Clinic in Vancouver, WA (Note: The Vancouver in the State of Washington, not in Canada), have released an informative and detailed assessment of the benefits and challenges of implementing medical scribes in a clinical setting.  Read the PowerPoint presentation that their researchers created here.

Slide 28 in the presentation summarizes some of the group's key findings:

The Scribe concept has additional potential for:

• Improving quality of documentation
• Expanding use of EMR
• One extra patient contact hour a day for seven
• Providers = one additional provider = increased patient
• Capacity without overhead

What we have to do differently:

• Cost and revenue need to be balanced for viability
• Providers must be chosen carefully

Risks:

• Cost of scribe
• Dependency of providers on scribe
• High scribe turnover

While we at Physicians Angels do not provide on-site scribes to clinic (ours work remotely, or "virtually," in real-time) -- thus, we would argue that we can manage the costs and turn-over of medical scribes more efficiently through our specialty team-based scribe operations -- we have found much of the Vancouver Clinic's research supported by our own internal research and six years of experience working with medical scribes in various clinical settings throughout the United States.

How to Lose Money with an EHR

Apparently, the easiest way to lose money with a new EHR in your practice is to do nothing, according to recent research supported by the Massachusetts Medical Society and American College of Physicians.

Electronic Health Records do not bring greater productivity and efficiency to your practice by themselves.  EHRs are a wonderful tool with great potential.  But everything depends on how you manage your time and staffing to manage that tool.  This article in Medpage Today, entitled "If Practices Don't Change, EHRs Lose Money," highlights this fact:

The average physician lost nearly $44,000 over 5 years implementing an electronic health record system, a large pilot study found, but the technology itself was just part of the reason....  

But the vast majority of practices lost money because they failed to make operational changes to realize the benefits of EHRs such as ditching paper medical records after adoption, Julia Adler-Milstein, PhD, of the University of Michigan in Ann Arbor, and colleagues wrote.

We would add virtual medical scribes to one of the operational changes necessary to ensure an effective EHR for your medical practice.  It's an argument we, and others, make throughout this blog, and in a growing body of medical practice management literature.  Medical scribes help answer the thousand-dollar question any doctor and practice manager has to consider when adopting a new EHR: Who is going to manage effectively for us all of this data in this new EHR tool we have introduced into our practice?

EHRs Lack the Human Element -- Medical Scribes -- to Manage Data Effectively

This March 10, 2013 New York Times article, "Algorithms Get a Human Hand in Steering Web," hints at the massive EHR data management problem our Virtual Medical Scribes tackle for healthcare practitioners -- namely, who (and we mean a human being here, not another software program) is going to input and manage all of this computer-generated data?

As the article lays out:

'For all their brilliance, computers can be thick as a brick,' said Tom M. Mitchell, a computer scientist at Carnegie Mellon University.

And so, while programming experts still write the step-by-step instructions of computer code, additional people are needed to make more subtle contributions as the work the computers do has become more involved. People evaluate, edit or correct an algorithm’s work... Humans can interpret and tweak information in ways that are understandable to both computers and other humans.

  

The human element:  This is sorely lacking in the EHR adoption policies undertaken by CMS, and ignored by many investing hundreds of millions in EHR technology.  Too few are investing the time and energy to ensure there is a new, highly-trained generation of healthcare workers able to input and manage EHR data for doctors and healthcare systems.  

We need people -- medical scribes, for example -- to ensure the money devoted to healthcare IT and EHRs is well-spent.  Fortunately, there more and more companies like Physicians Angels that are the addressing the needs and opportunities to improve the healthcare system for doctors and patients through better data management.  As more doctors and healthcare practice managers struggle with the crush and demands of EHR data, they will demand data management solutions, like medical scribes.  Articles like this one only echo the obvious to the thousands of doctors and office managers struggling with EHRs today.

Virtual Medical Scribe Benefits to ENTs

Our team at Physicians Angels is in the process of quantifying in greater detail the benefits of our Virtual Medical Scribe service to ENTs who employ it in their clinics.  As a large number of our clients and partners work in Otolaryngology, we have dug into the past six years of our operations and, so far, have found the following:

	With EHR, before scribes	With scribes
No. patients per clinic day	25	40
Add’l revenue per month	-$4,167	$6,250
Est. hours spent charting per clinic day	4	1.5
Est. hours spent charting per month	48	18

From our data, we see that ENTs net an additional $50,000 to $75,000 per year using our Virtual Medical Scribes.  This additional revenue is a direct result of these doctors being able to see more patients (conservatively, 4-5 more each clinic day) using our Virtual Medical Scribes, which results in more visit fees and ancillary revenue.  As for patient intake, we find these ENTs using Virtual Medical Scribes see 40-45 patients each clinic day.

Another way these clinics come out ahead using our Virtual Medical Scribes is that they eliminate transcription costs, which can run from $30,000 to $40,000 per year for a busy ENT.  Our Virtual Medical Scribes can provide a much more involved, value-added service than transcription for 20-30% less cost.

Additionally, these ENTs earn more revenue because their clinics are better able to reduce overhead costs and time spent training new staff.  By contracting with our Virtual Medical Scribe service, these ENTs' clinics eliminate the costs, time required, and risks that they would have had to take on with additional on-site staff to manage their EHRs and the data they generate.

Virtual Medical Scribes - How They Work

Why Virtual Medical Scribes?

Physicians Angels has provided Virtual Medical Scribe services to doctors nationwide since 2007.  We created the company out of personal frustrations with growing amounts of medical data that had to been entered into our EHRs, interfering with patient time.

We designed our Virtual Medical Scribe service based on research showing that EHRs increase data-entry time and medical office staffing cost, without demonstrating real gains in a doctor’s productivity.  We felt EHRs end up converting the most expensive labor – doctors and nurses – into low-paid, data-entry personnel.  Add to this the high cost of EHR software programs, and Physicians Angels identified a growing market need for data management personnel.  (This is one way to view a medical scribe.)

We also came to believe that, just as CT scanners and other expensive medical technology require trained technicians, EHRs require highly- trained medical scribes to ensure their efficient and productive use.

Our Virtual Medical Scribes – whom we call “Angels” – perform routine administrative functions for doctors that do not require more expensive onsite staffing.  Our Virtual Medical Scribes are located offsite in data management centers linked to a medical office via the Internet.  Imagine them as executive or medical assistants, but who work for your office remotely.

Among the core tasks our Virtual Medical Scribe "Angels" perform during medical exams:

- Transcribe patient visits for doctors in real-time, using VoIP software

- Document clinical information in the doctor’s EHR

- Enter relevant CPT/ICD codes into the EHR for billing purposes

- Process e-prescriptions in the doctor’s EHR

Our Virtual Medical Scribes learn a medical practice’s EHR – to date, we have worked successfully with several dozen – and adapt to the practice’s existing IT infrastructure.  We group our Virtual Medical Scribes by medical specialty and deliver our services via employee leasing arrangements.  This allows our scribes to develop strong working relationships with medical practices, while ensuring a consistent level of quality service.